HII Newport News Operations Summary Plan ... - Benefits Connect

If the claim for benefits is again wholly or partially denied, the beneficiary, within 90
days after the date of the notification, may submit a request in writing for a further
and final review to:
METLIFE
Group Life Claims
Oneida County Industrial park
Oneida 5950 Airport Road
Oriskany, NY 13424
The insurance company will consider the claim as promptly as possible, based upon
the claim itself and the record of the previous review, and will issue its decision, in
writing, within 60 days after receipt of the request for review.
Additional Information about the Appeals Process ⎯ In filing an appeal, your
beneficiary has the opportunity to:
• Submit written comments, documents, records and other information relating to
your claim for benefits
• Have reasonable access to and review, upon request and free of charge, copies of
all documents, records and other information relevant to your claim, including the
name of any medical or vocational expert whose advice was obtained in
connection with your initial claim
• Have all relevant information considered on appeal, even if it wasn’t submitted or
considered in your initial claim.
The decision on the appeal will be made by a person or persons at the claim
administrator who is not the person who made the initial claim decision and who is
not a subordinate of that person. In making the decision on the appeal, the claims
administrator will give no deference to the initial claim decision
If the determination is based in whole or part on a medical judgment, the claims
administrator will consult with a health care professional who has appropriate training
and experience in the field of medicine involved in the medical judgment. The health
care professional will not be the same individual who was consulted (if one was
consulted) with regard to the initial claim decision and will not be a subordinate of
that person.
At both the initial claim level, and on appeal, your beneficiary or authorized
representative may submit the appeal. In this case, the administrator may require the
beneficiary to certify that the representative has permission to act for him or her. The
representative may be a health care or other professional. However, even at the appeal
Life Insurance Plan
April 2011
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